Robotic repair of off-midline abdominal wall hernias: a single institution consecutive case series

While off-midline hernias represent only a small percentage of abdominal wall defects, symptoms can be debilitating for the affected patients, and repair portends substantial operative challenges for the surgeon. There are no large-scale case series that describe outcomes with extraperitoneal repair using the robotic approach. The objective of this study was to describe our experience of patients undergoing robotic repair of off-midline hernias at a tertiary care medical center.

This study was a retrospective review of patients who underwent elective robotic repair of off-midline hernias from June 2019 to October 2024. All adults (≥ 18 years old) diagnosed with a primary (no prior repair) or recurrent off-midline hernia were included. Patient demographics, preoperative clinical variables (smoking status, BMI, ASA score, co-morbidities, presence of pain, hernia type, history of prior hernia repair, type of prior flank operation, and dimensions of the hernia on CT scan), operative variables (perioperative regional pain blocks, operative approach, type and dimensions of mesh used), and postoperative outcomes (hospital length of stay (LOS), follow-up duration, hernia recurrences, and complications including wound occurrences and chronic pain defined as pain > 3 months postop) were abstracted from a prospectively maintained hernia database. Univariate analyses were used to measure and describe all covariates and outcomes.

There were 43 patients included in the study. Patients had an average age of 57.5 years and an average BMI of 32.8 kg/m2. 81% of the cohort identified as White race and 65% were female. 26% of the cohort had diabetes mellitus (average HbA1c 5.8), 7% had a smoking history, and 9% had COPD. Most hernias were incisional (51%) or traumatic (47%). Average hernia length and width were 8.0 ± 4.5 and 6.7 ± 2.7 cm. 98% had a clean wound classification. Fascial closure was performed in 86% of the cases and a mesh was placed in 98% of the cases. Average mesh length and width were 21.2 ± 5.9 and 21.1 ± 5.1 cm. There were 6 (14%) hybrid procedures, where the hernia was repaired via a combination of a robotic and open approach. Average hospital length of stay was 1.9 days and average follow up was 4.4 months. There were two (5%) recurrences. There were 15 (35%) postoperative complications. The most common complications were seroma (14%), hematoma (7%) and persistent pain > 3 months (5%). One patient (2%) developed an abscess, two patients (5%) had a nerve injury, and one patient (2%) had a postoperative small bowel obstruction.

Robotic off-midline hernia repair can be performed with minimal morbidity. Most common complication was postoperative seroma. Surgical outcomes were similar to existing literature on outcomes following open repair. Surgeons performing this repair should appropriately counsel their patients on the risks of pain and recurrence postoperatively.